Iatrogenic urosepsis. Causes and consequences

Bacteremia following transurethral instrumentation. The predictive value of a serum bactericidal activity test

The bacteremic rate following transurethral instrumentation and the possibility of a serum bactericidal activity test to predict which patients that were at an increased risk of developing bacteremia was evaluated. Of 33 investigated patients, all elderly men, 14 underwent transurethral prostatic resection, 14 cystoscopy and 5 urethrotomy. None of the patients received prophylactic antibiotic treatment. The majority (97%) of the patients had bacteria isolated from the urinary tract before the instrumentation. Gram-positive cocci accounted for about two thirds (64%) and Gram-negative rods for about one third (31%) of all isolates. The most frequent species isolated were coagulase negative staphylococci (29%), Streptococcus faecalis (19%) and Klebsiella pneumoniae (12%). The bacteremic rate was 21%. None of the patients developed septicemia. Forty-four per cent of the patients with greater than or equal to 10(5) colony forming units/ml (cfu/ml) in urine developed bacteremia compared with 8% in patients with a sterile urine or less than 10(5) cfu/ml in urine (p less than 0.05). The urethral/prostatic flora was the source of bacteremia in at least one patient. Eighty-one per cent of the isolated strains were serum resistant. About half (54%) of the Gram-negative rods were more or less sensitive against actual, fresh patient serum. All Gram-positive cocci were resistant. There was no difference in the serum sensitivity between bacteria isolated from bacteremic patients and non-bacteremic patients. In conclusion, this study confirmed the relative high risk of developing bacteremia following transurethral instrumentation, especially if the urine is infected.(ABSTRACT TRUNCATED AT 250 WORDS)

Urological septicemia. A retrospective study

In order to investigate the clinical course and outcome of septicemia in urological patients, data were collected retrospectively from all patients admitted to a specialized urological department, in whom positive blood cultures were drawn. During a 5-year period 91 patients were registered with urosepsis corresponding to an incidence of 1.2%. In non-iatrogenic urosepsis due to ureteral obstruction women dominated over men, however, in iatrogenic disease--after investigative manoeuvres as well as after surgery--men by large dominated the material. Gram-negative bacteria were responsible for almost 75% of the septicemias and for 99% of the cases where septic shock was present. Where a urinary infection was demonstrated prior to septicemia (45%- identical bacteria were subsequently found in the blood, whether the focus had been successfully treated or not. Septic shock developed in 20 of the patients of whom 3 died. This overall mortality of 3% occurred only in patients with comcomitant serious disease. In general the course of septicemia was benign and the complication rate low. It is concluded that in urological patients septicemia is a less serious problem than in gastroenterological patients. The possible explanation for this is discussed in relation to the more discrete diagnostic and therapeutical procedures in the urological clinic.